Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RX0202X | Medical Oncology | 3898 | OK |
Y | 207RX0202X | Medical Oncology | E9890 | AR |
NPI | 1083667737 |
---|---|
Provider Name | Simeon Jaggernauth |
First Address | Rogers, AR 72758-8939 |
Second Address | Rogers, AR 72758-8939 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 26/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H94210 | (02) | OK |